No abstract

Environmental allergens are known to contribute to poor asthma control. Therefore, this study aimed to evaluate the utility of serum environmental allergen testing in a cohort of patients with asthma to determine whether they enacted changes in their environment to avoid allergen triggers. METHODS: A sample of 99 children aged 4-17 with moderate-to-severe persistent asthma were offered free allergen testing as part of a clinical trial and agreed to participate in a follow-up survey on their test results. Univariate statistics were used to describe sample characteristics and survey responses. Chi-squares were used to test associations between categorical variables. RESULTS: The majority were male (67.7%) between 4-11 years old (82.8%). Racial distribution was even and over half (55.6%) had public insurance. The most common allergens were dog (49%) and cat (46.4%). The majority of the participants found allergen testing useful (94.4%). As a result, 26.8% began to actively avoid the child's indoor allergens, 18.3% began to avoid outdoor allergens, and 38.1% started their child an allergy medication regimen. Over a quarter of participants (25.4%) reported that awareness of the child's allergies to animals and insects was most useful. The most common changes made after learning of positive allergen test results were removing rugs (18.3%) and staying indoors due to high pollen (12.6%). CONCLUSIONS: These findings suggest environmental allergen testing is beneficial in children with asthma which can lead to positive behavior changes to avoid allergen triggers. Future research is needed to evaluate the impact of allergen avoidance on asthma outcomes.

Objective: This case study aims to review the management of pregnancy in a patient with Klippel Trenaunay syndrome (KTS), a rare condition characterised by venous malformations, affecting an estimated 1 in 30,000-100,000 live births (1). We focused on tailoring management to adverse outcomes specifically associated with this condition; including venous thromboembolism and postpartum haemorrhage. Design: We followed the case of a 35 year old primip who had been identified as needing specialist input for KTS at 35 weeks pregnant. Obstetric management was based largely upon current literature as there are no specific guidelines for the management of this condition in pregnancy. Methods: Recent literature was reviewed at the point of referral to antenatal clinic. Primary risks were identified including venous thromboembolism, post-partum haemorrhage, complicated administration of loco-regional anaesthesia and difficult delivery by caesarean section. In view of these risks, the patient was initiated on low molecular weight heparin, an MRI spine and pelvis was organised and a plan was made for induction at 38 weeks. Blood was crossmatched and readily available at delivery. The patient was reviewed by an anaesthetist and discussed in a multidisciplinary meeting prior to induction. Results: The patient was induced at 38 weeks and had a forceps delivery, with 800ml of blood loss. She unfortunately sustained a 3c tear which was repaired. Conclusion: Klippel-Trenaunay Syndrome is associated with significant morbidity at all stages of pregnancy and therefore requires careful multidisciplinary obstetric management. Specific anticipation of venous thromboembolism and post partum haemorrhage is needed. A guideline for management of KTS in pregnancy would be of great benefit.

Chronic cough is one of the most common reasons children seek care from their pediatrician. A cough can be distressing both to the patient and family as it may raise concerns for a significant underlying diagnosis that could warrant a thorough investigation. Chronic cough can be challenging for the family and the pediatrician due to its broad differential diagnosis. This article highlights an approach to categorizing the differential diagnoses of chronic cough to help guide testing or treatment when evaluating a pediatric patient with chronic cough. [ Pediatr Ann. 2019;48(3):e115–e120.]